Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist

Itskovitz, Joseph; Boldes, R.; Levron, Jacob; Erlik, Yohanan; Kahana, Luna; Brandes, Joseph M.

doi:10.1016/s0015-0282(16)54474-4

Cited by 279 publications

(28 citation statements)

References 22 publications

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“…The spontaneous LH surge is defined by a short ascending phase (14 hours), a peak phase (14 hours), and a descending phase (20 hours) while the GnRHa induced LH surge consisted of two phases: a short ascending limb (>4 hours) and a long descending limb (>20 hours) [25, 26]. The shortened surge may be responsible for accelerated degradation of the corpus luteum and a decrease in progesterone and E 2 in cycles triggered by GnRHa versus hCG [25, 27]. While serum E 2 and progesterone were not measured after trigger in our study, it can be hypothesized that their E 2 and progesterone in the GnRHa cycles were decreased and may have negatively impacted BPR and CPR.…”

Section: Discussionmentioning

confidence: 99%

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Lê

Nguyen

Zolton

et al. 2019

International Journal of Endocrinology

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This study is aimed at comparing clinical pregnancy rates (CPRs) in patients who are administered either gonadotropin-releasing hormone agonist (GnRHa) or human chorionic gonadotropin (hCG) for ovulation trigger in intrauterine insemination (IUI) cycles. A prospective randomized comparative study was conducted at Hue University Hospital in Vietnam. A total of 197 infertile women were randomly assigned to receive either GnRHa trigger (n=98 cycles) or hCG trigger (n=99 cycles) for ovulation trigger. Patients returned for ultrasound monitoring 24 hours after IUI to confirm ovulation. A clinical pregnancy was defined as the presence of gestational sac with fetal cardiac activity. There was no difference in ovulation rates in either group receiving GnRHa or hCG trigger for ovulation. Biochemical and CPR were higher in patients who received hCG (28.3% and 23.2%) versus GnRHa (14.3% and 13.3%) (p=0.023, OR 0.42, 95%CI=0.21−0.86 and p=0.096, OR 0.51, 95%CI=0.24−1.07, respectively). After adjusting for body mass index (BMI) and infertility duration, there was no difference in CPR between the two groups (OR 0.58, 95% CI 0.27-1.25, p=0.163). In conclusion, the use of the GnRHa to trigger ovulation in patients undergoing ovulation induction may be considered in patients treated with IUI.

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Section: Discussionmentioning

confidence: 99%

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Lê

Nguyen

Zolton

et al. 2019

International Journal of Endocrinology

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“…However, owing to the prolonged half-life and the sustained luteotropic activity of hCG (4), the risk of ovarian hyperstimulation syndrome (OHSS) is increased in patients hyperresponsive to ovarian stimulation. As an alternative to hCG, gonadotropin-releasing hormone agonist (GnRHa) elicits an endogenous surge of LH and follicular stimulating hormone (FSH) by acting at the GnRH receptors in the pituitary gland, leading to the reduction of OHSS incidence, and the retrieval of more MII oocytes (5, 6). To rescue the defective luteal phase function and subsequently comprised pregnancy outcomes caused by the GnRHa-induced luteolysis (6), the new concept of dual trigger has been introduced that combines a single bolus of GnRHa with a small dose of hCG (7, 8).…”

Section: Introductionmentioning

confidence: 99%

A Higher Estradiol Rise After Dual Trigger in Progestin-Primed Ovarian Stimulation Is Associated With a Lower Oocyte and Mature Oocyte Yield in Normal Responders

et al. 2019

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Background: Prior studies have shown that patients with a >10% estradiol (E2) rise after trigger had more oocytes retrieved than plateauing or decreasing E2 responders. However, multiple follicles develop at different stages of maturation during controlled ovarian stimulation (COS) and may exhibit different responses to trigger. The association between the magnitude of E2 increase and oocyte retrieval outcomes is still unclear.Methods: This was a retrospective cohort study of 2,898 women undergoing their first COS cycles with normal response from January 2014 to December 2017 at a tertiary-care academic medical center. Patients were categorized into five groups according to the percentage increase in E2 levels before and after dual trigger: <10.0%, 10.0–19.9%, 20.0–29.9%, 30.0–39.9%, and ≥40.0%. Univariable and multivariable linear regression analysis were performed to explore the association between E2 increase and oocyte/mature oocyte yield, while logistic regression was used to assess its effect on low oocyte/mature oocyte yield (<10th percentile).Results: The post-trigger E2 increase was negatively associated with both oocyte yield (P-trend < 0.001, adjusted P-trend = 0.033) and mature oocyte yield (P-trend < 0.001, adjusted P-trend = 0.002). Compared with a <10.0% E2 increase after trigger, patients with a ≥40.0% rise had fewer mature oocyte yield [adjusted mean absolute difference [MD] = −5.2, 95% confidence interval [CI]: −8.2–−1.8] and higher risk of low mature oocyte yield (adjusted odds ratio [OR] = 1.64, 95% CI: 1.04–2.60), whereas no statistical significance was found in oocyte yield (adjusted MD = −2.7, 95% CI: −6.1–0.8) and low oocyte yield (adjusted OR = 1.48, 95% CI: 0.96–2.28). In addition, the rates of implantation, positive pregnancy test, clinical pregnancy, ongoing pregnancy, pregnancy loss, and live birth were comparable among the 1,942 frozen embryo transfer cycles with embryos originating from different groups of E2 increase (all P > 0.05).Conclusions: A higher E2 rise after dual trigger is independently associated with a lower oocyte and mature oocyte yield in normal responders. Further studies are needed to explore the efficacy of individualized time interval from trigger to oocyte retrieval based on the magnitude of E2 increase after trigger.

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“…GnRH surge vs natural LH surge: GnRH agonist surge lasts for 24-36 hours and comprises only two phases of short ascending limb (lasting 4 hours) and long descending limb (lasting 20 hours) 22 in contrast to natural midcycle LH surge which lasts for 48 hours and consists three phases. 23 This difference has striking role in reduction of risk of OHSS, owing to shorter duration of endogenous LH surge 24 (Flowchart 2).…”

Section: Dose Of Hcg Triggermentioning

confidence: 99%

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

Malhotra¹,

Malhotra²,

Bora³

et al. 2020

Journal of South Asian Federation of Obstetrics and Gynaecology

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Human chorionic gonadotropin (hCG) has been the gold standard in the induction of final oocyte maturation since the pioneer days of in vitro fertilization (IVF). But owing to its long half-life, it leads to increased risk of ovarian hyperstimulation syndrome (OHSS). Trigger of GnRH agonist is a more physiological trigger, effective, and safe, as it significantly reduces or eliminates risk of OHSS. Newer options of dual trigger and double trigger are discussed in this review, which can be used as modified luteal phase support in patients with expected suboptimal oocyte maturation. Newer pharmaceutical options such as Kissepeptins, key in central regulation of neuroendocrine system, and GnRH release need more studies before being implemented in general practice. This review includes details of various trigger options for final oocyte maturation and about combination of trigger options aiming safe and effective outcomes.

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Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist

Cited by 279 publications

References 22 publications

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

A Higher Estradiol Rise After Dual Trigger in Progestin-Primed Ovarian Stimulation Is Associated With a Lower Oocyte and Mature Oocyte Yield in Normal Responders

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

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